Trouble with my T doctor

[Farm Boy]

Ok, so I've been on T for close to 4 months.  My doctor started me on a very low dose of cream, and has been raising my dose very slowly.  My next appointment isn't until next month, when I'll be almost 5 months in.  By then, my dosage will not even be half of what she says my full dose will be.  At this rate, I won't be at full dosage until an entire year has passed. 

I saw my therapist a few weeks ago and talked to her about it.  She agreed with me that this is an absurdly slow rate, and told me that it is not the norm in her experience.  The only changes I have noticed are a slight increase in size to my biceps after the first month (which I now question the accuracy of, since there has been no change since then) and maybe a bit more acne, but I've always had acne so I can't really count that as a sure thing either.  This is really frustrating, as most people I've seen have had notable changes by this point. 

Anyway, my therapist called my doctor and talked to her about it, and told her I wanted to increase my dose more quickly and that she supported the motion.  I got a call back from the doctor's assistant saying that I was to carry on doing what I've been doing until my next appointment, but that I was welcome to call back in a month if I still wasn't happy with how it was going.

I'm going to call back this week, but honestly I don't have high hopes because my doctor has insisted that her method is the way that it's done, and that I shouldn't give credence to the probably hundreds of Youtube videos I've watched, or the people I've met in real life or on this forum, or really any of the research I've done on the subject.  I'm trying to be patient, but I feel like my time is being wasted.  Does it really take an entire year for most people to reach a full dose of testosterone?  Is there something I'm missing here?

[Arch]

IRL, I have met dozens of trans guys, and I knew a lot of them when they were just starting out. I know of two for sure who were on a very low dose at first, and both had major health issues, and their docs wanted to take no chances.

The first guy was on something like 40% of what we call the "full dose," and that went on for a long time, but I'm not sure how long or where he wound up (I lost track of him). The second guy had high blood pressure and bipolar disorder. He started at 25%, went up to 50%, and then I think wound up at 75%, but he is very small. It took him several months to get to 50%. He's the only guy I know IRL who started so low.

I've met a few other guys who started on 50% and went up from there, but they didn't take a year. And I know some guys with and without health issues and whose T history I know nothing about.

I started on the "full" dose right away, but I was in my forties, and my endo said, "You want to masculinize as soon as possible." He sure wasn't wrong.

A lot of guys seem to start on a half dose and increase it sometime later, but a year seems like a long time. It certainly does seem that your doc is being very conservative, but different docs have different approaches, and I don't know anything about your medical history.

Maybe you should design a survey or a couple of surveys. I'm not sure how you would go about it, but the results would be interesting.

[Simon]

I've talked to a few guys who started out on gel at a very low dose and it was mainly due to either age or apprehension that the guy had about having fast changes. I mean who can blame someone for being nervous. Most major changes occur in the first six months on T and that is really lightning quick when you think about everything that occurs. Maybe your doctor has a reason they're doing it but if that is the case they should explain the situation to you. I'd personally demand an explanation but that's me. I'd simply state that it is my body and I would like to know why they want to keep me at a minimum dose. I'd tell them that it is causing undue stress by being in the "in between" stages for so long.

I'm kinda curious why they're doing this with you. I have a rare genetic disease and high blood pressure (controlled with a pill every day) but I started out with a 50% dose. Now I'm at 75% dose (I'll be a month on T the 18th) and plan on staying there until my blood work in March. Have you had your levels checked?

[Robert Scott]

My doctor started me out on a low dosage too .... I just reached a year on T and I just had my dose increased at my last apt which was about a month ago .... I know the new guidelines for doctors say they need to increase the dosage slowly so the body has time to adjust & reduces the changes of t rage ... I also know there is no longer a "normal" dosage... they have discovered folks react differently ... for example - I have had little changes and my dosage is now considered above "normal" dosage ...but my son is on 1/3 dosage of a "normal" dosage and he has had lots of changes & remains at that dosage for two years now - it's his maintenance dose

[Arch]

As Robert says, referring to "the full dose" is a bit misleading, which is why I usually put it into quotation marks. I'm just thinking that if your endo is so conservative, we don't even know what your final dosage will be. But, of course, we can't talk about it here.

I don't know about NHS procedures, but I do know that I've heard about a lot of variation here in the U.S. And procedures have been changing. Perhaps gradual increases are becoming more common. For example, Domnic's endo has been very cautious. However, your endo's insistence that this is "how it's done" is not accurate because there IS so much variation.

Even if docs are becoming more cautious about dosages, I would be frustrated if I were in your shoes. It can't hurt to talk to her, right? And definitely think about creating a survey here (or two or three), just to satisfy your curiosity.

[Farm Boy]

I don't have any medical problems that conflict with HRT, so that can't be it.  I did have a higher T level to begin with (still in normal female range, though) and she has given this as a reason for going so slow.  She says people who go faster often freak out and turn into rage monsters (not using exact words here), and since I had a higher level to begin with that it would be more likely to happen to me.  It's my understanding that the whole rage thing is largely a myth, and even if I did feel more cranky I like to think I'm enlightened enough to realize why and be able to deal with it effectively.  I'm 22, not 12.

I just did some math, and I started on 10% of the "full dose" for two months, then went to 20% for a month, and am at 40% now.  That's a good point too, Arch.  I don't know what my "full dose" looks like next to somebody else's "full dose," and it's hard to get an idea because most people do injections and the dosage isn't comparable to cream.  My final dose may end up being higher or lower than she's said, too, I'd just like to get there and find out what does work for me.

Simon- I haven't had my levels checked yet, but I'm supposed to for my appointment next month.  I just don't want to wait another month to get bloodwork that says my body still isn't freaking out when I can just tell her that on the phone.  The only reason I see myself raging at someone is because I am frustrated at being stuck in the "in between" stage for so long, and possibly longer depending on how willing she is to work with me.

I'll work on making a survey, too.  I'm interested to see how it's gone for others.

[Arch]

I don't have any medical problems that conflict with HRT, so that can't be it.  I did have a higher T level to begin with (still in normal female range, though) and she has given this as a reason for going so slow.  She says people who go faster often freak out and turn into rage monsters (not using exact words here), and since I had a higher level to begin with that it would be more likely to happen to me. 

Wow, seriously? I've talked to a lot of trans guys IRL...I've never met a single one who had problems with rage after T, although some of them had it in spades beforehand. Most of us seem to calm down after starting HRT.

I started becoming more competitive and impatient a month or two in, and I realized that I was driving more aggressively than usual, so I dealt with it by keeping a close eye on my freeway habits. No tickets, no accidents, no road rage. I was definitely worried, but I handled it. Eventually, I settled down a lot.

Now I realize that I was so unused to feeling emotions of any kind that this was all new to me. I was coming out of my emotional numbness right before HRT, and I was getting in touch with ALL of my feelings. So I was angry before HRT. By the time I noticed that I was driving more aggressively, I was finding out that my job might go away (in a bad economy), I was trying to commit to top surgery, and my nineteen-year relationship was going south fast, so I was worried about a breakup. In short, I had a lot going on to be worried about.

I still get impatient in stores when people get in my way, but I certainly don't act on it. I do growl a little, but I don't think people can hear me.

[Simon]

She says people who go faster often freak out and turn into rage monsters (not using exact words here), and since I had a higher level to begin with that it would be more likely to happen to me.

Where are these transmen who become "roid rage monsters"? I'd like to know because my Endo basically said the same to me when I was starting.

Honestly I'm a lot more even tempered since my hysto and starting T. It takes a lot to get me angry. I get annoyed easily because I have a low tolerance for stupidity...but angry, hardly ever.

[Arch]

I do think that T contributes to a certain degree of aggressiveness, and I feel that I'm an example of that. But that's not the same thing as uncontrolled anger or even violence. Aggression automatically gets a bad rap from most people, and it shouldn't, unless it's violent or overly pushy. For instance, I'm much more aggressive in seeking out opportunities to further my career or just get what I want or need. I'm not obnoxious about it, just assertive. And that's a good thing, believe me. I used to be...well, I wasn't at all assertive except in unusual circumstances.

Here's a funny, though. I was at a support group, and we were all sitting at tables in a rough square. Someone in the group, I think a pre-T guy, expressed concern that he would have problems with anger and aggression once on T. Three of the guys who were already on T exclaimed almost simultaneously, "T doesn't ramp you up! IT CALMS YOU DOWN!!!" They were definitely ramped up, and a couple of them were leaning forward aggressively on the table. That was as far as it went, though. No swearing, no fighting. Still cracks me up. To be fair, one of those guys had serious rage issues before T, and he really was calmer afterward.

[ntxboi]

I am at 1 month in started on a very low dose and not scheduled to follow-up or increase for another couple of months. I have seen no changes thus far, which is very frustrating - so I totally get where you are at.

[tvc15]

I might posit that a lower dose exacerbates rage issues. I guess it's one thing if your doc is at least keeping your schedule consistent, i.e. giving you a small shot every week or putting you on a gel that is not very potent. But my doctor started me off on a low dose and I had only one shot per month. I experienced masculinization, but for example, I didn't stop menstruating until we ramped up my dose for the second time. I was on this very low dose for quite a few months and I was a crazy emotional mess. There's no way my hormone levels could've been consistent on that infrequent a schedule; I think my T and E were both out of whack. I got really aggressive and violent. I've always had those problems, but they weren't as quick to bubble up as they were when I started T. That's the key though--I'd bet if you don't have an aggressive past, "T rage" probably won't hit you. But it hit me, and hard. I try to share my experiences when the subject comes up, because it happened to me, and I'm sure it happens to other people. T is not some wonder drug that instantly makes you cool and happy with yourself 100%. It's a powerful hormone and it might just mess with you as you enter your second puberty. Of course, I seem to be a minority, but in the off chance another guy starts T and feels rage, it sucks when everyone else tells you "Oh, that doesn't ever happen, T makes you calm." YMMV, and all that.

[Zerro]

Wtf do we all have the same endo? Mine said I would become an uncontrollable monster while on T. Five months in, I'm a little more impatient, but my temper is about the same.

I think you need to be a bit more tough with your doctor, she's just putting you off and that's not cool. If you feel like this dose isn't working for you at all, you may need it changed. Since everyone reacts differently, you need something more individualized. Maybe a shot and maintenance gel or something along those lines. Either way, your doctor should listen to your concerns instead of brushing you off.

[Felix]

I think I started at a quarter of what I'm on now (which is an average dose) and took a month or so of increases to get to my current dose. I was 30 and had been talking about it for a couple of years when I went on T though, so the doctor couldn't have had any misgivings about my identity and what hormones would do for me.

What you are dealing with sounds very frustrating and I hope it doesn't continue like that for much longer.

[Farm Boy]

Thanks, guys!  I'll call tomorrow and see how it goes.  With any luck she'll Ok me to raise it before my next appointment.

[Jared]

I've also had higher T levels to start (higher than the average female should have) but I started on a "full dose". My endo also told me this rage monster thing, the only thing I noticed is it takes more activity to be tired at the end of the day. I feel a bit more frustrated if I'm lazy whole day 

[Arch]

Another thing to consider is whether your inner parts are still a going concern when you start T (I had already reached menopause, but most of us haven't). Adolescent cis boys' hormones do not have to "duke it out" with functional ovaries when their T levels start to rise. We do. I don't know what the endocrinological wisdom is on this, but low T levels can cause all sorts of ills for cis men. With us, when we're just starting out, who knows?

[aleon515]

"Roid rage" is ridiculous. I can't believe endos propagating this myth. It's not the same as anabolic steroid.

--Jay

[Farm Boy]

Well, I talked to my doctor's assistant again.  She said the same thing as last time.  I'm supposed to wait until my next appointment, and then we'll talk about raising it.  I talked more this time, and expressed my frustration that it would likely be 6 months before I was even at a half dose at this rate.  She seemed confused why I was unhappy with the way things were going, and just confused in general, but she is the assistant after all and not the doctor, so maybe that's why.  This didn't go the way I'd hoped it would, but she moved my next appointment up a bit. 

I'm not an assertive person, so I'm trying to work out the difference between asserting myself and just being a jerk.  I feel like I'm being rude when I push an issue, but this is important.  I don't know what to do if she still refuses to take this any faster.  I'd really prefer to work things out with her than look for another doctor to start over with, especially since the next closest one is an hour away.  :/

[Arch]

Well, gee, aren't you supposed to go in there and throw furniture around and brandish a flamethrower?

(How bloody frustrating, but at least you got your appointment moved.)

[Wolf Man]

Well, gee, aren't you supposed to go in there and throw furniture around and brandish a flamethrower?

(How bloody frustrating, but at least you got your appointment moved.)

Agreed. At least you're closer to the chance. Be assertive. If you're worried about being a jerk, then you won't get to that point. I'm the same way, but you need to push for this since it's so important to you. It may work, it may not. It worked for me until I wanted a full dose and then it didn't work, but it was worth it to have it raised as much as it was.

Hijack Alert:

Testosterone IS an anabolic steroid and mood changes, that can be associated to "roid rage", can happen. I think it happens due to a hormone imbalance. I know I was being prescribed too much for a single shot when I was on them biweekly. During that time I was violent and overly aggressive, just overall being a Hulk, as noted by both my SO and my roommate. Once it was split and made weekly it evened out and my moods got better.  It also seems that this happens most frequently with Test. Cypionate, the most commonly prescribed type.

Sorry for hijacking, I'm done now.